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Invited Commentary
December 29, 2021

Untangling Access and Quality in the VA Health Care System: Measuring Black Holes in Observational Studies

Author Affiliations
  • 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
JAMA Surg. 2022;157(3):239. doi:10.1001/jamasurg.2021.6548

Over the past decade, concerns about delays in the VA system have spurred legislation to make health care outside the VA system more accessible for veterans.1 As George et al1 remind us, however, better access to health care does not necessarily result in improved outcomes. By showing that veterans have lower 30-day postoperative mortality in VA hospitals compared with private sector hospitals, they demonstrate the important distinction between quality of care and timeliness of access. George et al should be congratulated for bringing this important policy issue to light, and for reminding us that improving patient outcomes requires attention not only to access to care, but also to quality of care.

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